作　　者： ; ; ; ;

机构地区： 高州市人民医院

出　　处： 《岭南急诊医学杂志》 2019年第4期330-332,共3页

摘　　要： 目的:探讨曲前列尼尔在先天性心脏病合并重度肺动脉高压围术期的应用效果。方法:2018年1月-2018年10月高州市人民医院心脏外科先天性心脏病合并重度肺动脉高压的患者21例。所有患者体外循环下行心脏畸形纠正术。术毕予曲前列尼尔中心静脉微泵给药至术后30日,起始剂量1.25 ng/kg/min,每12-24小时增加1-2 ng/kg/min,如可耐受逐渐增加至目标剂量10-15 ng/kg/min,如不可耐受,可考虑维持或降低剂量。30日后右心导管检测血流动力学参数。结果:患者术后7日心排指数(CI)及BNP与术前比较P<0.05,术后30日5个血流动力学指标较术前均P<0.05。患者使用呼吸机时间为(50.6±13.68)小时,ICU住院时间为(4.3±2.7)天,住院30天内死亡患者1例。曲前列尼尔使用剂量及并发症:患者达到的最大剂量中位数为11.5.0 ng/kg/min,剂量上调时间中位数为17天。使用过程中出现头痛者5例,腹泻者3例,恶心者2例,下颌痛2例,没有严重血流动力学不良事件。结论:先天性心脏病合并重度肺动脉高压患者围术期使用曲前列尼尔可有效降低肺动脉压力,改善心功能,使用快速静脉剂量调整的方法是安全的可耐受的。 Objective:To investigate the effect of traprostadil in the perioperative period of congenital heart disease with severe pulmonary hypertension.Methods:From January 2018 to October 2018,21 patients with congenital heart disease and severe pulmonary hypertension in cardiac surgery of Gaozhou People′s Hospital were enrolled.All patients underwent cardiac malformation correction under cardiopulmonary bypass.After operation,tramadol was administered by central venous micropump until 30 days after operation.The initial dose was 1.25 ng/kg/min,increasing by 1-2 ng/kg/min every 12-24 hours.If tolerable gradually increased to the target dose of 10-15 ng/kg/min,if not tolerable,the dose could be maintained or reduced.Hemodynamic parameters were measured by right cardiac catheter 30 days later.Results:1.Hemodynamic changes:CI and BNP at 7 days after operation were compared with those before operation(P<0.05),and 5 hemodynamic indexes at 30 days after operation were all P<0.05.2.Prognosis:The duration of ventilator use was(50.6±13.68)hours,ICU hospitalization was(4.3±2.7)days,and 1 patient died within 30 days of hospitalization.3.Dose and complications of traprostadil:The median maximum dose of traprostadil was 11.5.0 ng/kg/min,the median time interval of dose increase was 17 days.There were 5 cases of headache,3 cases of diarrhea,2 cases of nausea and 2 cases of mandibular pain during the use.There were no serious adverse hemodynamic events.Conclusion:Traprostadil can effectively reduce pulmonary artery pressure and improve cardiac function in patients with congenital heart disease complicated with severe pulmonary hypertension during perioperative period.Rapid intravenous dose adjustment is safe and tolerable.

关 键 词： 曲前列尼尔 先天性心脏病 肺动脉高压

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